Utilization Management for Medications for Opioid Use Disorder in Medicaid

In this session, staff provided information about states’ use of utilization management policies for medications for opioid use disorder (MOUD). MACPAC analyzed states that made their utilization management policies for oral buprenorphine less restrictive over time (e.g., removed prior authorization or increased the daily dosage limit) using the Transformed Medicaid Statistical Information System (T-MSIS) data. This analysis found that from calendar years 2019–2023, the share of individuals with Medicaid and the State Children’s Health Insurance Program (CHIP) with opioid use disorder who were treated with oral buprenorphine increased, while treatment continuity for all types of MOUD decreased. Our analysis also found that in general, policies to remove prior authorization in some form were associated with increased rates of oral buprenorphine fills and decreases in opioid-related overdoses and opioid-related emergency department (ED) visits. States that increased their daily dosage limits to at least 32 milligrams per day experienced a decrease in opioid-related ED visits and no change in the rate of opioid-related overdoses.